Pediatric Skin Disorders

1. Pediatric Skin Disorders

2. Compare skin differences • Infant: skin not mature at birth • Adolescence: sebaceous glands become enlarged & active.

3. Skin Assessment • Assess history • Assess exposure • Assess character • Assess sensation

4. Dermatitis

5. Dermatitis • Inflammation of the skin that occurs in response to contact with an allergen or irritant; also referred to as “contact dermatitis”

6. Dermatitis • Common irritants: Soap, fabric softeners, lotions, urine and stool ♦ Common allergens poison ivy, poison oak lanolin, latex, rubber nickel, fragrances

7. Dermatitis: signs and symptoms • Erythema • Edema • Pruritus • Vesicles or bullae that rupture, ooze and crust

8. Dermatitis: Treatment • Medications • Application of a corticosteroid topical agent: remind pt to continue use for 2-3 wks after signs of healing • Application of protective barrier ointments Oatmeal baths, cool compresses Antihistamines given for sedative effect

9. Eczema • Chronic superficial skin disorder characterized by intense pruritis

10. Erythematous patches with vesicles Pruritis Exudate and crusts Drying and scaling Lichenification (thickening of the skin) Eczema: signs and symptoms

11. Eczema, cont.

12. Goal of Treatment • Hydrate the skin

13. Treatment of Eczema • Emollients (creams which lubricate the skin) • Oral antihistamines (control itching) • Antibiotics (treat superinfections) • Corticosteroids (anti-inflammatories) • Immunomodulators (inhibit T lymphocyte activation) • AVOID SOAPS!

14. Acne

15. Acne • Inflammatory disease of the skin involving the sebaceous glands and hair follicles. • Contributing factors include: heredity, hormonal influences and emotional stress

16. Acne: Three main types • Follicular plugs • Pustular papules • Cystic nodules

17. Patient teaching • Do not pick! This increases the bacterial count on the surface of the skin and opens lesions to infection which worsens scarring • Remind patients that the treatment will not show improvement until about 4-6 weeks but they must consistently follow the regime set up by the physician

18. Medical treatment for acne • Topical (Benzoyl peroxide, Tretinoin (RetinA), topical preferred to systemic; however, both may be needed • Oral: Tetracycline, minocycline, erythromycin; estrogen for female pts., Accutane

19. Acne: Nursing care • Avoid picking and squeezing • Use gentle skin cleansers • Avoid use of astringents containing ETOH • Avoid hats or abrasive rubbing of the skin • Wash hands after handling greasy foods • Limit use of petrolatum-based hair products; hair away from face • Use oil-free makeup, protections from windy, cold weather • Continue therapy even when improved

20. Impetigo http://www.emedicine.com/emerg/topic283.htm Impetigo became infected • Hemolytic Strep infection of the skin • Incubation period is 2-5 days after contact

21. Begins as a reddish macular rash, commonly seen on face/extremities • Progresses to papular and vesicular rash that oozes and forms a moist, honey colored crust. Pruritis of skin • Common in 2-5 year age group

22. Therapeutic Management • Apply moist soaks of Burrow’s solution • Antibiotic therapy: Keflex for 10 days • Patient education

23. Therapeutic Interventions for impetigo • Goal: prevent scarring and promote + self image. • Individualize treatment to gender, age, and severity of infection • Takes 4-6 wks to improve • What is the major nursing implication here?

24. Candiditis- Thrush Overgrowth of Candida albicans Acquired through delivery

25. Thrush • Characterized by white patches in the mouth, gums, or tongue • Treated with oral Nystatin suspension: swish and swallow

26. Dermatophytosis (Ringworm) • Tinea Capitis fungal infection known as “ringworm” • Transmission: • Person-to-person • Animal-to-person

27. S&S: • Scaly, circumscribed patches to patchy, gray scaling areas of alopecia. • Pruritic • Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)

28. http://www.ecureme.com/quicksearch_reference.asp

29. Clinical manifestations • Fungal infection of the stratum corneum, nails and hair (the base of hair shaft causing hair to break off…rarely permanent) • Scaly, patches • Pruritis • Generally asymptomatic, but severe reactions may appear as encrusted lesions

30. Tinea: signs and symptoms

31. Therapeutic Interventions • Transmitted by clothing, bedding, combs and animals (cats especially) • May take 1-3 months to heal completely, even with treatment • Child doesn’t return to school until lesions dry

32. Diagnosis • Potassium hydroxide examination • Black Light

33. Medication Therapy • Antifungals: • Oral griseofulvin (Lamisil) • Give with fatty foods to aid in absorption • Treatment is 4-6 wks • Can return to daycare when lesions are dry

34. Pediculosis Capitis (lice) • http://www.emedicine.com/emerg/topic409.htm • a parasitic skin disorder caused by lice • the lice lay eggs which look like white flecks, attached firmly to base of the hair shaft, causing intense pruritus

35. Diagnosis • Direct identification of egg (nits) • Direct identification of live insects

36. Pediculosis

37. Medication Therapy • Treatment: shampoos RID, NIX, Kwell(or Lindane) shampoo: is applied to wet hair to form a lather and rubbed in for at least amount of time recommended, followed by combing with a fine-tooth comb to remove any remaining nits.

38. Scabies http://www.nlm.nih.gov/medlineplus/scabies.html Sarcoptes scabei mite.  Females are 0.3 to 0.4 mm long and 0.25 to 0.35 mm wide.  Males are slightly more than half that size. • A parasitic skin disorder (stratum corneum- not living tissue) caused by a female mite. • The mite burrows into the skin depositing eggs and fecal material; between fingers, toes, palms, axillae • pruritic & grayish-brown, thread-like lesion

39. http://www.aad.org/pamphlets_spanish/sarna.html Scabies between thumb and index finger On foot

40. Therapeutic Interventions • transmitted by clothing, towels, close contact • Diagnosis confirmed by demonstration from skin scrapings. • treatment: application of scabicide cream which is left on for a specific number of hours (4 to 14)to kill mite • rash and itch will continue until stratum corneum is replaced (2-3 weeks)

41. Care: • Fresh laundered linen and underclothing should be used. • Contacts should be reduced until treatment is completed.